Choosing and Preparing for Bariatric Surgery

Northern California Bariatric Surgery Program

Choosing and Preparing for Bariatric Surgery (Book One)

Roux-En-Y Gastric Bypass

Sleeve Gastrectomy





*Please bring this binder to every appointment*

Edition March 2020

Northern California Bariatric Program

TABLE OF CONTENTS

TABLE OF CONTENTS................................................................................................................ 2 Chapter 1: Intro to the Northern California Bariatric Surgery Program ......................................... 5

Welcome ..................................................................................................................................... 5 Who qualifies for Bariatric Surgery?.......................................................................................... 5 Regional Bariatric Centers.......................................................................................................... 6 Read this entire workbook carefully. .......................................................................................... 6 Chapter 2: Obesity and Weight Loss Surgery................................................................................. 7 Obesity is common and serious .................................................................................................. 7 How does food lead to obesity? .................................................................................................. 8

Fat is a "savings account" of food we do not use right away. ............................................ 8 Metabolic Adaptation can make fat loss difficult. .............................................................. 8 Understanding the calories in our food can help us understand why we gain fat............... 9 How does bariatric surgery help lose fat?................................................................................. 10 Weight Loss After Surgery ....................................................................................................... 10 Conditions Improved with Weight Loss with Bariatric Surgery .............................................. 11 Diabetes (Adult onset) .......................................................................................................... 11 Heart disease and strokes ...................................................................................................... 11 Hypertension ......................................................................................................................... 12 Elevated Cholesterol ............................................................................................................. 12 Sleep Apnea .......................................................................................................................... 12 Arthritis ................................................................................................................................. 12 Kidney Disease ..................................................................................................................... 13 GERD, Heartburn, and Acid Reflux ..................................................................................... 13 Polycystic ovary syndrome (PCOS) and Infertility .............................................................. 13 Fatty Liver............................................................................................................................. 13 Pseudo Tumor Cerebri .......................................................................................................... 14 Lung Disease......................................................................................................................... 14 Cancer risk ............................................................................................................................ 14 Psychosocial.......................................................................................................................... 14 Chapter 3A: Surgery as a Treatment for Obesity.......................................................................... 15 The Normal Digestive System .................................................................................................. 15

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Types of Weight Loss Surgery ................................................................................................. 16 Open and Laparoscopic Procedures.......................................................................................... 17 Chapter 3B: Roux-En-Y Gastric Bypass vs Sleeve Gastrectomy................................................. 19 Roux-en-Y Gastric Bypass ....................................................................................................... 19 Sleeve Gastrectomy .................................................................................................................. 21 Hiatal Hernia............................................................................................................................. 21 Weight loss and Medical Conditions after gastric bypass vs sleeve gastrectomy .................... 22

Weight loss............................................................................................................................ 22 Diabetes................................................................................................................................. 22 GERD and acid reflux........................................................................................................... 22 Early complications of the gastric bypass and sleeve gastrectomy .......................................... 23 Mortality (death) ................................................................................................................... 23 Leak....................................................................................................................................... 23 Bleeding ................................................................................................................................ 23 Blood clots ............................................................................................................................ 23 Respiratory and cardiovascular problems ............................................................................. 24 Late complications of gastric bypass and sleeve gastrectomy.................................................. 24 Ulcers .................................................................................................................................... 24 Narrowing ............................................................................................................................. 25 Dumping syndrome and hypoglycemia ................................................................................ 25 Internal hernia, intussusception, and small bowel blockage................................................. 25 Gallstones.............................................................................................................................. 26 Nutritional or vitamin deficiencies ....................................................................................... 26 Weight re-gain ...................................................................................................................... 26 Kidney stones........................................................................................................................ 26 Other side effects and excess skin ........................................................................................ 27 TABLE: Comparison of the Operations ................................................................................... 28 Gastric Bypass .......................................................................................................................... 28 Sleeve Gastrectomy .................................................................................................................. 28 How Do I Choose?.................................................................................................................... 29 Chapter 4. Preparation Before Surgery ......................................................................................... 30 Preparing for Weight Loss Surgery .......................................................................................... 30

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Hospitalization .......................................................................................................................... 31 The first month.......................................................................................................................... 31

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Northern California Bariatric Program

Chapter 1: Intro to the Northern California Bariatric Surgery Program

"Knowing is not enough, we must apply. Being willing is not enough, we must do." Johann Wolfgang von Goethe

Welcome

The Kaiser Permanente Bariatric Surgery Programs offer a team-oriented approach to the management of obesity and include the expertise of surgeons, bariatric physicians, psychologists, registered dietitians, registered nurses, health educators, and support staff. Our teams are committed to a goal of maximizing your chances for success while minimizing your risks. Although the operation itself is an important part of the program, it is only one tool that may help you achieve and maintain weight loss. Successful weight loss requires a commitment to lifelong changes: eating fewer calories, eating healthier foods, eating mindfully, taking vitamins, exercising regularly, and feeling psychologically and socially supported.

Who qualifies for Bariatric Surgery?

Weight loss operations are appropriate for adult members (over age 18) with a: ? Body Mass Index (BMI) greater than 40 or ? Body Mass Index (BMI) greater than 35 with a serious weight related condition

The body mass index is a calculation based on your weight and height. If you want to know your exact BMI, the actual calculation uses kilograms divided by meters squared, so it is easiest to use an online BMI calculator. The ideal candidate for surgery is the person who has seriously tried to lose weight in the past, understands the risks and benefits of surgery, understands the lifelong changes in lifestyle required for success, and has the support of family and friends to help him or her through the process. If you meet the criteria above, your primary doctor can refer you to the bariatric program. It is important to remember that the ultimate decision on whether bariatric surgery is right for you rests with the multidisciplinary bariatric team.

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Northern California Bariatric Program

Regional Bariatric Centers

In general, surgical centers that perform a high number of weight loss operations perform the operations with lower risk and lower complications. Centers with multidisciplinary teams focused on weight loss education are shown to improve long term weight loss success. For this reason, regional bariatric centers were created to provide patients with the maximum expertise and safety. The Kaiser Permanente Northern California Bariatric Centers are:

? Fremont ? Fresno ? Richmond ? South San Francisco ? South Sacramento Our outcomes and results are tracked and reported regularly, and our mortality and complication rates remain consistently better than the national averages. You can find out more about each site on our website:



Read this entire workbook carefully.

? It contains the information you need to prepare for bariatric surgery and to be successful after your surgery!

? Your knowledge of the process and the impact on your way of life will significantly help you achieve your goals.

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Chapter 2: Obesity and Weight Loss Surgery

Obesity is common and serious

Obesity refers to having too much fat in your body. Your excess fat can be roughly estimated by your body mass index. A normal BMI is about 18 to 25. A BMI over 25 is considered overweight, a BMI over 30 is considered obese, and a BMI over 40 is considered morbidly obese.

In 2016, about 93 million people in the United States, or roughly 40% of the population, were obese.

The reasons for obesity are very complex and not yet fully understood.

Some the factors are:

? Food choices and eating patterns ? Lack of physical activity ? Genetics ? Differences in absorption ? Medical conditions ? Medications.

Obesity can contribute to some of the leading causes of preventable death such as:

? Diabetes mellitus ? Hypertension ? Heart disease ? Stroke ? Lung disease ? Sleep apnea ? Certain types of cancer

Obesity can also contribute to other medical problems such as:

? Arthritis and joint pain ? Infertility, Polycystic Ovary Syndrome ? Psychological problems

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? Heartburn /gastroesophageal reflux disease (GERD) ? Incontinence ? Skin infections and ulcers

How does food lead to obesity?

Fat is a "savings account" of food we do not use right away. Humans eat food to obtain energy. Our body breaks down food until it is liquified and absorbed by our digestive system into the blood stream, and then sent to all the cells in our body to be used for energy. Energy from our food is measured in calories. If all the calories from food are not used within a few hours, the extra calories are stored as fat. This is your body's built in system to ensure survival when there is no food. Every pound of fat contains about 3,500 calories and represents 3,500 calories of food that was eaten but not used.

Every time you eat more calories than you use, you make fat. The only way to lose fat is to eat less and use more energy by being active. This forces your body to use the energy stored in your fat, and "tap into your savings account". You will need to use up around 3,500 calories to lose about one pound of fat.

Calories digested (Eaten) HIGH Low

Calories used (activity) Low HIGH

FAT MAKE FAT Lose fat

Metabolic Adaptation can make fat loss difficult. Most people need a minimum amount of energy to live every day, even if they are not very active. This is called your basal metabolism. It is the energy you need to breathe, keep your body warm, and live. Although many people think that the average diet should be about 2000 calories a day, most people can live on less than that. If you are not very active, then even 2000 calories a day can lead to fat gain.

Our bodies will accept growing and gaining weight, but our bodies do not recognize when we are overweight. There are no natural drives in our bodies that help us lose weight, but there are many natural mechanisms that try to maintain our weight no matter what it is. When people go on a very low-calorie diet suddenly or start starving themselves, their bodies view this as dangerous. To prevent you from dying, your body will lower your basal metabolism more than usual. This means that you can survive on even less calories than you needed before. This "metabolic adaptation" is another survival mechanism that allows your body to survive much

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